Choroidal Metastases In Patients Research Articles

Effective Treatment of Choroidal Metastasis With ALK Inhibitor Chemotherapy That Crosses the Blood–Brain Barrier

Purpose: We report a case of metastatic non-small cell lung cancer (NSCLC) with choroidal metastasis, which responded to oral ensartinib. Methods: Retrospective case report on a 44-year-old male with a past medical history significant for metastatic NSCLC with a positive anaplastic lymphoma kinase (ALK) translocation that was treated for 4 years with oral crizotinib systemically, and bevacizumab intravitreal injections for management of subretinal fluid associated with a left macular choroidal metastasis. The vision was maintained at 20/25 to 20/40, but there was steady growth in the breadth and thickness of the choroidal lesion. Results: Two months after starting daily oral ensartinib, his vision improved from 20/40 to 20/20. His lesion decreased significantly in size, with resolution of his subretinal fluid, and has not required any additional bevacizumab intravitreal injections in the 8 months since starting ensartinib. Conclusion: Ensartinib may be beneficial in the treatment of choroidal metastases in patients with NSCLC with ALK mutations.

Choroidal metastasis response to crizotinib in a ROS1-rearranged NSCLC patient

Choroidal metastases are uncommon metastasis from non-small cell lung cancer (NSCLC). With improved survival from the use of targeted therapy against actionable driver mutation driven NSCLC, the incidence of choroidal metastases seems to be increasing. Recently, there are several case reports of choroidal metastases in patients with anaplastic lymphoma kinase (ALK)-driven NSCLC one of which the patient's choroidal metastases had responded to crizotinib, multi-targeted tyrosine kinase inhibitor against ALK/ROS1/MET. Similarly ROS1-rearranged NSCLC has very similar clinicopathologic characteristics as ALK-rearranged NSCLC and crizotinib has demonstrated significant clinical activity against ROS1-rearranged NSCLC. Here in this report we presented a patient with ROS1-rearranged NSCLC that presented with choroidal metastases that did not respond to initial chemotherapy but had a rapid and complete response to crizotinib. Although likely to be exceeding rare, choroidal metastases from ROS1-rearranged NSCLC can be successfully treated with crizotinib similar to choroidal metastases from ALK-rearranged NSCLC can be successfully treated from another case report.

Three-dimensional spectral domain optical coherence tomography of retina in choroidal metastasis due to breast and lung carcinoma

Intraocular metastasis is now considered the most common malignancy of the eye [1]. The frequency of choroidal metastasis in patients with cancer is estimated to be approximately 2 to 7 % [2, 3]. While any portion of the eye can be involved by metastatic disease, the most common tissue involved is the highly vascular choroid [1–3]. There seems to be no predilection for metastasis to preferentially affect the right or left eye [3]. In each affected eye, more than one metastasis may be noted [4]. Most choroidal metastases occur posterior to the equator of the fundus, in the macular or paramacular regions. The common primary sites of cancer are the breast, lung, and gastrointestinal tract [2, 3]. Diagnosis of ocular metastases is based primarily on clinical findings supplemented by imaging studies. Spectral domain optical coherence tomography (SD-OCT) clearly outlines the changes in the retinal architecture due to the underlying choroidal mass. 3D SD-OCT feature of retina following choroidal metastasis due to uterine endometrial carcinoma has been reported by Saxena et al. [5]. 3D SD-OCT in choroidal metastasis due to breast and lung carcinoma is being reported for the first time.

Choroidal Metastasis with Adenocarcinoma of the Lung Treated with Gefitinib

To report a case of bilateral regression of choroidal metastasis with adenocarcinoma of the lung treated with gefitinib. Retrospective case review of a 68-year-old woman with pulmonary adenocarcinoma with choroidal metastasis who presented with visual loss in the left eye as the initial manifestation. Her visual acuity was 6/6 in the right eye and 6/60 in the left eye before the start of gefitinib administration. Best-corrected visual acuity and spectral-domain optical coherence tomography were compared between baseline and 3 months after treatment. Best-corrected visual acuity in the left eye had improved to 6/30 3 months after oral gefitinib. The elevated lesions of the right eye disappeared, with decrease of subretinal fluid and retinal pigment epithelial atrophy. Spectral-domain optical coherence tomography showed that subretinal fluid of the left eye was also reduced. Oral gefitinib could be effective for regression of choroidal metastasis in patients with adenocarcinoma of the lung and provides a potential treatment option.

Radiotherapy of Choroidal Metastases in Patients with Disseminated Cancer

Background: >Choroidal metastasis is the most common ocular tumor, in most cases related to breast and lung cancer. Radiotherapy (RT) mostly is the therapy of choice. However, there is a lack of data about the results of uniformly, prospective treated patients. Patients and Methods: Between November 1994 and September 1997, 37 patients with 49 metastatic eyes were enrolled into the study. 25 patients (68%) had unilateral and 12 patients (32%) had bilateral metastases. 21 patients had breast cancer as primary tumor, 12 patients lung cancer, and 4 patients other tumors. 3 patients were excluded from analysis, 34 patients with 46 involved eyes were available for analysis. 29 of those patients had symptomatic metastases, 5 patients had asymptomatic choroidal metastases. RT was performed with bi- or unilateral asymmetric fields, total dose was 40 Gy with a single dose of 2 Gy, 5 fractions per week. 12 patients (35%) had a chemotherapy following RT due to diagnosis of general tumor progression. Endpoints of the study were visual acuity (VA), local tumor control, survival, and side effects. Results: The median follow up was 6 months, 22 out of 34 patients died of metastatic disease. In 17 of symptomatic eyes (53%) an increase of VA and in 11 of symptomatic eyes (34%) a ‘no change’ was achieved. The local tumor control rate after 18 months was 83%. One patient with asymptomatic metastasis (1/14 eyes) developed symptoms until death. The median survival time was 15 months. Altogether, in 2 patients late side effects (6%) were observed (1 patients with bilateral retinopathy, 1 patient with optic nerve atrophy). Conclusions: RT with 40 Gy is highly effective in the treatment of symptomatic and asymptomatic choroidal metastases, VA was stable or improved in almost 90% of treated eyes. The rate of side effects is low.

Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme

AIMTo determine the frequency of visually asymptomatic choroidal metastasis in patients with disseminated breast cancer and its dependence on the incidence of metastasis by number and site of other organ...

Metastatic Tumors to the Eye and Orbit

• A review of the charts of 112 patients (141 eyes) presenting with a metastasis to the eye or orbit revealed that breast cancer was the most common primary tumor (49.1%). The median survival time (MST) following choroidal metastasis for all stages of breast cancer was 314 days. The MST after choroidal metastasis in patients thought to have stage I or II breast cancer, prior to diagnosis of the metastasis, was longer than that of patients with stage III or IV cancer (873 vs 139 days, respectively). Lung cancer metastasized to the eye and orbit earlier than did breast cancer (276 vs 1266 days, respectively) and had a shorter MST following this metastasis (188 vs 666 days, respectively). When age was considered as a continuous variable, the data indicated that older patients with breast metastases survived longer than did younger patients. Echography demonstrated that choroidal metastases from breast tumors were thicker than those from lung tumors (3.70 vs 2.59 mm, respectively).

Metastatic tumors to the eye and orbit. Patient survival and clinical characteristics.

A review of the charts of 112 patients (141 eyes) presenting with a metastasis to the eye or orbit revealed that breast cancer was the most common primary tumor (49.1%). The median survival time (MST) following choroidal metastasis for all stages of breast cancer was 314 days. The MST after choroidal metastasis in patients thought to have stage I or II breast cancer, prior to diagnosis of the metastasis, was longer than that of patients with stage III or IV cancer (873 vs 139 days, respectively). Lung cancer metastasized to the eye and orbit earlier than did breast cancer (276 vs 1266 days, respectively) and had a shorter MST following this metastasis (188 vs 666 days, respectively). When age was considered as a continuous variable, the data indicated that older patients with breast metastases survived longer than did younger patients. Echography demonstrated that choroidal metastases from breast tumors were thicker than those from lung tumors (3.70 vs 2.59 mm, respectively).